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PRE 2010 DOCSVillage of Fridley, Minn. BUMI)ING PERMIT �° 1730 Date: .......`............. ... .... . Owner ....................................... Builder??......�or '! Address...................................... Address ....'-�. ..�.......... . . .. ..... �7 L A OF BUILDING No. .. 1 . � S -k -Street .... ................ Part of Lot .... Lot ... ........ Block ...../......... dition or Sub -Division .....4!.... . . Corner Lot ........... Inside Lot ........... Setback`s..... Sideyard ...................... DESCRIPTION OF BUILDING To be used 7 Front .2. ji�. Depth .47. Height ..4� / Sq. Ft. ........ Cu. Ft. ........ ..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction .7 ..... Est. Cost... .. �f - .. To be Completed .................. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. er � In consideration of the payment of a fee of $. �'�'..... , permit is hereby granted to ..... !'' '%a 4 mz . . ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. V... Building Inspector NOTICE: Vr This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. City of Fridley Application for Phanbing and C•n Rthing Permit 87 9 • n Z Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK 7558 NE 5 Wit• Number, Kind and Location of Fixtures Location —7558 rn x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Z Q _ N W = z $ W yz Z �n CSO • R N WATER HTR. GAS ELEG Base $ GAS FITTING FEES: NO. RATE TOTAL 1st r 1 2nd _ 3rd 4th • Future Connection Openings a New Fixture, Old Openings I Connected with Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... .............. x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... .................. .. x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. ............ x $3.25 $ Electric Water Heater a $2,00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU ...... 6 P.7 .. —I x $5.00 $---3- 0 0 REPAIRS & ALTERATIONS—Refer to Code City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn 27 sato 67 , 19_ Owner G .Anderson Kind of Building I r Used as r e S To be completed about 2" OC t Estimated Cost, $5.00 Old—New. Building Permit No P' mit N . By Business Phone No FINAL � - `7 - 40 Description ...................$ 3.00 TOTAL FEE $ 42 City of Fridley, Minn. BUILDING PERMIT • Date: — August 20, 1968 • • Owner: Address Gerald D. Anderson 7558 5th St. N. E. Builder Same Address Same N9 9894 LOCATION OF BUILDING No. __15 5 8 Street _ 5th S t . N. E. ---- Part of Lot — Lot _ 1 ._.....__ Block 3 — Addition or Sub -Division ._ _ _ Osborne Manor Corner Lot —_ Inside Lot _ _ Setback Sewer Elevation Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front — 26' Depth —22' Height —10, Sq, Ft. 572 Cu. Ft 5720 Front Depth __ _ Height — Sq. Ft. — Cu. Ft. Type of Construction — Frame Est. Cost _ _1000 To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of OA of the city of Fridley. , In consideration of the payment of a fee of $—_2.LQ_, permit is hereby granted m Gerald Anderson to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. f-� Clarence Belisle NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, Acs hooting, sewer or water. Be sure to see the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY Or, FRIDLEY, MINNESOTA OWN11 'S NAME C.9dAu2 0 ZIA& Q CLdSQ _/L1_BUILDER ,2�.. ADDRESS :Zs sa: &� 6--" S1 ADDRESS 5,d=l-- LOCATION OF BUILDING - NO. 2 S fir' STR LOT- BLOCK 3 ADDITION OR SUBDIVISION ajZoff 11lAjplr .e COR-NM LOT INSIDE LOT SETBACK SEWER ELEVATION TOP OF FOOTING, .S IDEYARD Applicant attach to this form. T-YTo (ertifioates of Survey of Lot and proposed building location drawn on theso Certificates. DESCRIPTION 017 BUIIJ)ING To Be Used As: 0.46,+6G,6 a2 / Front __-1, a ' Depth Square feet rz$ Z Cubic Feet Height Front Depth Height Square feet Cubic Feet Type of Construction Estimated Cost o 'n To Be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side.) 0 ;. __ __ __ -- .-- r _ ___ ff -- I � - - � � - - - �� i �� _;�_ - � - - --; -- � i i 1--i -� - - i _� --�- i --t- - - � __ �_ -- -i _ -j- -- 1- � _�_ � - - _ �_ i --} I_ -- - - - - _ _ _. j � • � - -- { - - - - ' -t-- -- r- i � j I - _ _ _- - � - Application for Power Plants and Heating. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace®O ............................. 5.00 $-.2 Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .... ..... . ...... 2.50 $ OIL BURNER—to 3 gal. per hour ....................... 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ..................... �,- 5.00 $�_ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $j % $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule TOTAL FEE Dept. of Bldgs. Phone M-3450 / Loc.... iia .NF 5Z�, City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application qy true and correct. Fridley. Owner ae ee Kind of Building Used as To be completed about ® �Qi / JP6 ,? Estimated Cost, $�v Old ew. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Via m Ai No Trade Nam Size No A fez Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Loa 9/ Kind of Fuel BURNER — Trade Nam " Size No Capacity Sq. Ft. E.D.R BTU H.P. Signe By 0 <2 Business Phone No �� - X 0 (REMARKS -OVER) SUBJECT City of Fridley 21 S 3 2 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. 6. _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. s �; ��� r NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 L 612-571-3450 910—F15 5/6/93 JOB ADDRESS 7558 5th ST NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE GEORGE OLSON 7558 5th ST NE FRIDLEY MN 55439 673^5841 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. SELA ROOFING 4100 EXCELSIOR BLVD ST LOUIS P 6 1050 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RESIDENTIAL 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE D REMOVE XX 8 DESCRIBE WORK RER OF 9 CHANGE OF USE FROM TO STIPULATIONS SEE NOTATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 756e 00 •50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL AW REGULATING CON- 21.00 FIRE SC 76 STRNOR THE PERFORMANCE CONST TION. . PLAN CHECK FEE TOTAL FEE ` 5,00 LIC. SC 27.26 SIG QATURE OF CONTRACT ROR AU AORIZED AG T IDATEI P PERY LIDD THIS IS YOUR PERMIT 4W4H14 INSR PATE S,GNATURE OF OWNEROF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/93 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: �� 5 '57 Legal Description: LD 4r� Owner Name & Address:© Tel. # 0-3 3 Contractor: --:::> ;� 1 � �� � MN LICENSE # n <--v, Address: (� �- S res� �)y A Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Legh OTHER: Comer Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: DESCRIPTION OF IMPROVEMENT Ft. Width Width Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ (Cost on Back) Driveway Curb Cut Width Needed: Ft. Ft = Ft x � \/tet., DATE:5-- a(• j APPLICANT: Tel. # Permit Fee $ / 141:290 Fire Surcharge $ s State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $750 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ Z7, 26 & 1) STIPULATIONS: � • I SUBJECT PER - City of Fridley 7 AT THE TOP OF THE TWINS BUILDING PERMIT r O • COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC. r � � NUMBERREV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/26/95 / , / JOB ADDRESS 7558 5 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Osborne SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jeff Nelson-Bungert 7558 5 Street NE 784-2850 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 28" (off ground) by 101 x 8' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING Before digging call for all utility locations 454-0002 REQUIRED BY LAW. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 652 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANC F CONSTRUCT) N r $21.00 Fire SC .65 L� 6 �/ o� PLAN CHECK FEE TOTAL FEE j%�� IXTURj OF CONTRACTOR OR AUTHORIZED A NT ID EI WHEN PROPE VALIDATED THIS IS YOUR PERMIT 'BL G )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI I NEW ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: ,/ < 5 Q`'j /Lr Legal Description: Owner Name & Address: SGC 1yl e _ lue 15c; — cti erl- _ Contractor: Address: MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Tel. # Effective 1/ 1/95 DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. _ GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length dIQ f2� Width Hgt/Ground c-&/ Sq. Ft. OTHER: Comer Lot [ ] Inside Lot [ j Ft. Yd Setback Side Yard Setbacks Type of Construction: &v r e !j Zt eaf e Estimated Cost: $ � Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ _ $ DATE: as 1� APPLICANT: �` Tel. # M--29 0 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 01.00 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $850 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] $-,:)2 , s - NZ W SUBJECT P City of Fridley 24171 AT THE TOP OF THE TWINS BUILDING PERMIT r O. � ; L ______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. S( r �;? y CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 5/13/9 JOB ADDRESS 7558 5 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Osborne Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jeff Nelson -Bun ert 7558 5 9frept NE 784-2850 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 101 x 3.5' Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. DECK ADDITION BUILT BEFORE PERMIT WAS ISSUED - FOOTINGS NOT INSPECTED. n WARNING Before digging call for all utility locations 454.0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $300 �.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $21.00 Fire SC $.30 PLAN CHECK FEE TOTAL FEE 21.80 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPE VALIDATED THIS IS YOUR PERMIT 14P All ,� - 3 81,ZG INSP GATE SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI NEW [ ] ADDN [ l CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: Legal Description: '<5.�f-) ?ifGt Owner Name & Address: �Sa P117 4P Tel. # Contractor: MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Effective 3/1/96 Length Width Height Sq. Ft. Length Width Height Ft. Length /D � Width Hgt/Gro d—�G . . Ft. Comer Lot [ ] Inside Lot [ql" Type of Construction: Approx. Completion Date: Ft. Yd Setback Side Yard Setbacks �� Estimated Cost: $ J o (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: Y/7/ 2 APPLICANT: 90a,Tel. RV V/7 CITY USE ONLY Permit Fee $ y () Fee Schedule on Reverse Side Fire Surcharge $ 3Q .001 of Permit Valuation (1/10th%) State Surcharge $ �7) $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ `' Cao STIPULATIONS: Fy-i'd Re y PbR141Y # �2 3 y8 C4- ` y .s iR. ry° t 'P 4�r P 3 rya f r�"�,� ��R-�c• 7 r _ r�diey V Building MECHANICAL Permit No. Inspections RESIDENTIAL APPLICATION 763-572-3604 Received By: CITY OF FRIDLEY Date: AUG 12 763-502-4977 FAX EFFECTIVE 1-1-08 JUL DATE YOUR E-MAIL ADDRE S .eseg) SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: OWNER/ TENANT ADDRESS: CITY STATE IP 3 PHONE: CONTRACTOR COMPANY NAME: n �i t•wMw�O l_ uIwlf� NOTE: . . AIR SEPARATE CITY CONTACT PERSON: 54 82 LICENSES ARE STATE LICENSE # rGVCTeI a�diA REQUIRED FOR GAS AND HVAC. ADDRESS: XCITY STATE—ZIP— TATEZIPSUBMIT SUBMITCOPY OF BOND - PHONE FAX AND INSURANCE PERMIT TYPE 4NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW PLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK N PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) OR Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU MFG: MODEL: SIZEIBTU /A/C $25.00 _FIREPLACE (GAS) $15.00 RANGE/OVEN $10.00 _GAS _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 GAS GRILL $10.00 _NEW _BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 _ —CHIMNEY LINER $10.00 _GAS DRYER $10.00 HEATER $35.00 _POOL _DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 ' . r d3 �eY,G ie :i.$".�.Lrci�G.�',-fl. NOW Permit Fee $ U Number of fixtures @$10.00 x $10.00 =$ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $-,V- TOTAL DUE $ 600._!p OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical permit and I acknow ge the in above is complete and accurate; that the work will be in conformance with the ordinances :natipon and codes of the City of Fridley and with the Minn to Co do ; that Iu)derstand this is not a permit but onl an application for a permit and work is not to start without a permit; that the work will be in acro ce the ap lana case of all work which ire vi w and approval of plans. SIGNATURE OF APPLICANT PRINT NAME J V DATE APPROVED BY �yyDATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 )08 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS iNiXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations.